72 results on '"Laura Scelsi"'
Search Results
2. Impediments to Heart Transplantation in Adults With MELAS:m.3243A>G Cardiomyopathy
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Alessandro Di Toro, Mario Urtis, Nupoor Narula, Lorenzo Giuliani, Maurizia Grasso, Michele Pasotti, Carlo Pellegrini, Alessandra Serio, Andrea Pilotto, Elena Antoniazzi, Teresa Rampino, Lorenzo Magrassi, Adele Valentini, Anna Cavallini, Laura Scelsi, Stefano Ghio, Massimo Abelli, Iacopo Olivotto, Maurizio Porcu, Antonello Gavazzi, Takahide Kodama, and Eloisa Arbustini
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Cardiology and Cardiovascular Medicine - Published
- 2022
3. Gaps of evidence in pulmonary arterial hypertension
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Carmine Dario Vizza, Stefano Ghio, Roberto Badagliacca, Giovanna Manzi, Laura Scelsi, Paola Argiento, and Michele D'Alto
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Pulmonary Arterial Hypertension ,Humans ,Familial Primary Pulmonary Hypertension ,risk stratification ,pulmonary arterial hypertension ,therapeutic approach ,familial primary pulmonary hypertension ,humans ,risk assessment ,Cardiology and Cardiovascular Medicine ,Risk Assessment - Published
- 2022
4. Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation
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Luca Arzuffi, Alessandro Mandurino-Mirizzi, Giulia Magrini, Romina Frassica, Giandomenico Disabato, Marco Ferlini, Fabrizio Gazzoli, Laura Scelsi, Annalisa Turco, Andrea Munafò, Stefano Ghio, Maurizio Ferrario, Luigi Oltrona-Visconti, and Gabriele Crimi
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
5. Response to acute vasodilator challenge and haemodynamic modifications after MitraClip in patients with functional mitral regurgitation and pulmonary hypertension
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Alessandro Mandurino-Mirizzi, Andrea Munafò, Claudia Raineri, Giulia Magrini, Romina Frassica, Luca Arzuffi, Laura Scelsi, Annalisa Turco, Marco Ferlini, Fabrizio Gazzoli, Maurizio Ferrario, Stefano Ghio, Luigi Oltrona-Visconti, and Gabriele Crimi
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Cardiac Catheterization ,Treatment Outcome ,Hypertension, Pulmonary ,Vasodilator Agents ,Hemodynamics ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,General Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine - Abstract
The effectiveness of transcatheter edge-to-edge repair (TEER) in patients with functional mitral regurgitation (FMR) and pulmonary hypertension (PH) is still debated and pre-procedural predictors of haemodynamic improvement after TEER in this setting are currently unknown. We investigated whether normalization of pulmonary artery wedge pressure (PAWP) in response to sodium nitroprusside (SNP) during baseline right heart catheterization might be predictive of a favourable haemodynamic response to MitraClip in patients with FMR and PH. Among 22 patients enrolled, 13 had a positive response to SNP (responders), nine were non-responders. At 6-months follow-up, responders showed a 33% reduction in PAWP and a 25% reduction in mean pulmonary artery pressure (PAP) (P = 0.002 and 0.004, respectively); no significant change occurred in non-responders. In patients with FMR and PH, pre-procedural vasodilator challenge with SNP may help define patients who may have haemodynamic improvement after TEER.
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- 2022
6. 121 RELEVANCE OF COMORBIDITIES ON INITIAL COMBINATION THERAPY IN PULMONARY ARTERIAL HYPERTENSION
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Silvia Papa, Roberto Badagliacca, Michele D´alto, Stefano Ghio, Paola Argiento, Natale Brunetti, Gavino Casu, Nadia Cedrone, Marco Confalonieri, Marco Corda, Michele Correale, Carlo D´agostino, Giuseppe Galgano, Giovanna Manzi, Valentina Mercurio, Massimiliano Mulè, Giuseppe Paciocco, Emanuele Romeo, Laura Scelsi, Davide Stolfo, Patrizio Vitulo, and Carmine Dario Vizza
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Cardiology and Cardiovascular Medicine - Abstract
Rationale Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting. Methods The study enrolled 181 treatment-naive PAH patients with a 6- months (IQR 144-363 days) right heart catheterization and risk assessment after initial oral combination therapy. Results Group-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median -45.0%, -30.3%, -24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15-4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities. Conclusion Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment- induced decrease in PVR.
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- 2022
7. Role of cardiac magnetic resonance in the differential diagnosis between arrhythmogenic cardiomyopathy with left ventricular involvement and previous infectious myocarditis
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Davide Colombo, Annalisa Turco, Sara Lomi, Adele Valentini, Emilio Bassi, Laura Scelsi, Alessandra Greco, Sandra Schirinzi, Michela Zacchino, Mauro Acquaro, Federico Oliveri, Lorenzo Preda, and Stefano Ghio
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Cardiology and Cardiovascular Medicine - Abstract
Arrhythmogenic cardiomyopathy with left ventricular involvement (ACM-LV), particularly in case of isolated left ventricular involvement (i.e. left dominant arrhythmogenic cardiomyopathy, LDAC) and previous infectious myocarditis (pIM) may have overlapping clinical and cardiac magnetic resonance (CMR) features. To date, there are no validated CMR criteria for the differential diagnosis between these conditions. The present study aimed to identify CMR characteristics to distinguish ACM-LV from pIM.This observational, retrospective, single-centre study included 30 pIM patients and 30 ACM-LV patients. In ACM-LV patients CMR was performed at diagnosis; in patients with pIM, CMR was performed six months after acute infection. CMR analysis included quantitative assessment of left ventricle (LV) volumes, systolic function and wall thicknesses, qualitative and quantitative assessment of late gadolinium enhancement (LGE) sequences. Compared with pIM, ACM-LV patients showed slightly larger LV volumes, more frequent regional wall motion anomalies and reduced wall thicknesses. ACM-LV patients had higher amounts of LV LGE and extension. Notably, the LDAC subgroup had the highest amount of LV LGE. LV LGE amount 15 g and a LV LGE percentage 30% of LV mass discriminated ACM-LV from pIM with a 100% specificity. LGE segmental distribution was superimposable among the groups, except for septal segments that were more frequently involved in ACM-LV and LDAC patients.A great extension of LV LGE (a cut-off of LGE15 g and a percentage above 30% of LV LGE in relation to total myocardial mass) discriminates ACM-LV from pIM with extremely high specificity.
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- 2022
8. Is it time for a paradigm shift: Should double‐lung transplant be considered the treatment of choice for idiopathic pulmonary arterial hypertension and giant pulmonary aneurysm?
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Cristiano Primiceri, S Pelenghi, Laura Scelsi, Mirko Belliato, Stefano Ghio, and Pasquale Totaro
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Idiopathic Pulmonary Arterial Hypertension ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Aneurysm ,030228 respiratory system ,Ventricle ,medicine.artery ,Pulmonary valve ,Pulmonary artery ,medicine ,Lung transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Idiopathic pulmonary arterial hypertension is a rare condition, frequently complicated by pulmonary arteries' aneurysm. Aggressive medical therapy is often unsatisfactory and lung transplantation remains the only option. We report a unique case of severe idiopathic pulmonary arterial hypertension complicated by a giant pulmonary aneurism, massive pulmonary valve regurgitation, and right ventricle dysfunction. The patient was, as our first choice, listed for heart-lung transplantation and remained in emergency list for more than 7 months. Unfortunately, due to further clinical deterioration and the unavailability of a heart-lung bloc, plan B was mandatory. The patient underwent a combined procedure including: double lung transplant, pulmonary artery plasty, and sutureless pulmonary valve prosthesis with open deployment (first-in-man use in such scenario). Postoperative outcome was uneventful. Our thought is that double lung transplantation and conventional combined pulmonary artery/valve surgery should be considered as the first option avoiding excessive waiting times and potential further clinical deterioration.
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- 2021
9. Risk stratification and response to therapy in patients with pulmonary arterial hypertension and comorbidities: A COMPERA analysis
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Stephan Rosenkranz, Christine Pausch, John G. Coghlan, Doerte Huscher, David Pittrow, Ekkehard Grünig, Gerd Staehler, Carmine Dario Vizza, Henning Gall, Oliver Distler, Marion Delcroix, Hossain A. Ghofrani, Ralf Ewert, Hans-Joachim Kabitz, Dirk Skowasch, Juergen Behr, Katrin Milger, Michael Halank, Heinrike Wilkens, Hans-Jürgen Seyfarth, Matthias Held, Laura Scelsi, Claus Neurohr, Anton Vonk-Noordegraaf, Silvia Ulrich, Hans Klose, Martin Claussen, Stephan Eisenmann, Kai-Helge Schmidt, Bjoern Andrew Remppis, Andris Skride, Elena Jureviciene, Lina Gumbiene, Skaidrius Miliauskas, Judith Löffler-Ragg, Tobias J. Lange, Karen M. Olsson, Marius M. Hoeper, Christian Opitz, Pulmonary medicine, and ACS - Pulmonary hypertension & thrombosis
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Pulmonary and Respiratory Medicine ,Transplantation ,Pulmonary Arterial Hypertension ,4-strata approach ,comorbidities ,kt ,mortality ,pulmonary arterial hypertension ,risk ,Hypertension, Pulmonary ,Risk Assessment ,Peptide Fragments ,Natriuretic Peptide, Brain ,Humans ,Surgery ,Familial Primary Pulmonary Hypertension ,Cardiology and Cardiovascular Medicine ,Aged ,Follow-Up Studies - Abstract
BACKGROUND: A diagnosis of idiopathic pulmonary arterial hypertension (IPAH) is frequently made in elderly patients who present with comorbidities, especially hypertension, coronary heart disease, diabetes mellitus, and obesity. It is unknown to what extent the presence of these comorbidities affects the response to PAH therapies and whether risk stratification predicts outcome in patients with comorbidities. METHODS: We assessed the database of COMPERA, a European pulmonary hypertension registry, to determine changes after initiation of PAH therapy in WHO functional class (FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) or N-terminal fragment of probrain natriuretic peptide (NT-pro-BNP), and mortality risk assessed by a 4-strata model in patients with IPAH and no comorbidities, 1-2 comorbidities and 3-4 comorbidities. RESULTS: The analysis was based on 1,120 IPAH patients (n = 208 [19%] without comorbidities, n = 641 [57%] with 1-2 comorbidities, and n = 271 [24%] with 3-4 comorbidities). Improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk from baseline to first follow-up were significantly larger in patients with no comorbidities than in patients with comorbidities, while they were not significantly different in patients with 1-2 and 3-4 comorbidities. The 4-strata risk tool predicted survival in patients without comorbidities as well as in patients with 1-2 or 3-4 comorbidities. CONCLUSIONS: Our data suggest that patients with IPAH and comorbidities benefit from PAH medication with improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk, albeit to a lesser extent than patients without comorbidities. The 4-strata risk tool predicted outcome in patients with IPAH irrespective of the presence of comorbidities. ispartof: JOURNAL OF HEART AND LUNG TRANSPLANTATION vol:42 issue:1 pages:102-114 ispartof: location:United States status: published
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- 2022
10. Pre-existing type 2 diabetes is associated with increased all-cause death independently of echocardiographic predictors of poor prognosis only in ischemic heart disease
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Giovanni Targher, Pier Luigi Temporelli, Erberto Carluccio, Calogero Falletta, Catherine Klersy, Olga Vriz, Angela Beatrice Scardovi, Marco Guazzi, Andrea Rossi, Laura Scelsi, Egidio Traversi, Frank Lloyd Dini, Stefano Ghio, and Pompilio Faggiano
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Male ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Myocardial Ischemia ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Risk Assessment ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Cause of Death ,Internal medicine ,Diabetes mellitus ,Type 2 diabetes mellitus ,medicine ,Risk of mortality ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,Cause of death ,Heart Failure ,Nutrition and Dietetics ,Ejection fraction ,business.industry ,Troponin I ,Hemodynamics ,nutritional and metabolic diseases ,Retrospective cohort study ,Prognosis ,medicine.disease ,Chronic heart failure ,Cardiac biomarkers ,Diabetes Mellitus, Type 2 ,Heart Disease Risk Factors ,Echocardiography ,Heart failure ,Cardiology ,Etiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background and aims It is unknown whether the prognostic role of diabetes (T2DM) in outpatients with chronic heart failure (CHF) is independent of the most important echocardiographic markers of poor prognosis. The aims of this analysis were to evaluate whether T2DM modifies the risk of mortality in CHF patients stratified by etiology of disease or by right-ventricular to pulmonary arterial coupling at echocardiography and to evaluate how T2DM interacts with the prognostic role of cardiac plasma biomarkers. Methods and results This is a retrospective analysis of 1627 CHF outpatients who underwent a complete echocardiographic examination. During a median follow-up period of 63 months 255 patients died. Poor right-ventricular to pulmonary arterial coupling and reduced left ventricular ejection fraction were independent predictors of outcome, whereas ischemic etiology and T2DM were not. T2DM interacted with etiology increasing the risk of mortality by 32% among patients with ischemic disease (p = 0.003). Elevated hsTNI plasma levels were associated with poor survival in T2DM but not in non-diabetic patients. Conclusion T2DM signals a worse outcome in ischemic CHF patients regardless of the echocardiographic phenotype. High plasma levels of hsTNI are stronger predictors of mortality in CHF patients with T2DM than in patients without diabetes.
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- 2020
11. Iron deficiency in pulmonary arterial hypertension: prevalence and potential usefulness of oral supplementation
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Claudia Raineri, Luigi Oltrona Visconti, Stefania Guida, Chiara Gargiulo, Eleonora Vullo, Anna Clizia Capettini, Laura Scelsi, Annalisa Turco, Stefano Ghio, Federico Fortuni, and Alessandra Greco
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medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Hypertension prevalence ,medicine.artery ,Internal medicine ,Prevalence ,medicine ,Humans ,In patient ,030212 general & internal medicine ,education ,Pulmonary Arterial Hypertension ,education.field_of_study ,Anemia, Iron-Deficiency ,medicine.diagnostic_test ,business.industry ,General Medicine ,Iron deficiency ,medicine.disease ,Dietary Supplements ,Pulmonary artery ,Serum iron ,Cardiology and Cardiovascular Medicine ,business ,Decreased transferrin saturation ,Iron depletion - Abstract
Background: The aim of this study was to evaluate the prevalence of iron depletion in a prevalent population of patients with pulmonary arterial hypertension (PAH) and to gain preliminary insights on the possibility of its treatment with oral drugs.Methods: Iron status was determined in 31 consecutive prevalent idiopathic patients with PAH. Iron depletion was defined as serum iron
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- 2020
12. Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study
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Erberto, Carluccio, Dini, Frank L., Bitto, Roberto, Michele, Ciccarelli, Michele, Correale, Andreina, D’Agostino, Dattilo, Giuseppe, Marco, Ferretti, Arianna, Grelli, Stefania, Guida, Francesca, Jacoangeli, Laura, Lupi, Lorenzo, Luschi, Daniele, Masarone, Valentina, Mercurio, Giuseppe, Pacileo, Nicola Riccardo Pugliese, Antonella, Rispoli, Laura, Scelsi, Carlo Gabriele Tocchetti, Natale Daniele Brunetti, Alberto, Palazzuoli, Massimo, Piepoli, Savina, Nodari, Giuseppe, Ambrosio, Working Group on Heart Failure of the Italian Society of, Cardiology., Carluccio, Erberto, Dini, Frank L., Bitto, Roberto, Ciccarelli, Michele, Correale, Michele, D'Agostino, Andreina, Dattilo, Giuseppe, Ferretti, Marco, Grelli, Arianna, Guida, Stefania, Jacoangeli, Francesca, Lupi, Laura, Luschi, Lorenzo, Masarone, Daniele, Mercurio, Valentina, Pacileo, Giuseppe, Pugliese, Nicola Riccardo, Rispoli, Antonella, Scelsi, Laura, Tocchetti, Carlo Gabriele, Brunetti, Natale Daniele, Palazzuoli, Alberto, Piepoli, Massimo, Nodari, Savina, and Ambrosio, Giuseppe
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Ejection fraction ,Heart failure ,Hemodynamic ,Prognosis ,Sacubitril/valsartan ,Aminobutyrates ,Biphenyl Compounds ,Hemodynamics ,Tetrazoles ,Heart failure, Ejection fraction, Hemodynamic, Prognosis, Sacubitril/valsartan ,Stroke Volume ,Angiotensin Receptor Antagonists ,Drug Combinations ,Treatment Outcome ,Echocardiography ,Humans ,Valsartan ,Cardiology and Cardiovascular Medicine - Abstract
Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect.To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome.In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/mAt baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P 0.05).In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions.
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- 2022
13. 380 Left heart disease phenotype and use of pulmonary vasodilators in elderly patients with pulmonary arterial hypertension: the Patriarca registry
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Matteo Toma, Roberta Miceli, Edoardo Bonsante, Marco Confalonieri, Andrea Garascia, Stefano Ghio, Mariangela Lattanzio, Carlo Mario Lombardi, Giuseppe Paciocco, Cristina Piccinino, Irene Rota, Laura Scelsi, Piermario Scuri, Davide Stolfo, Antonella Vincenzi, Marco Vicenzi, and Pietro Ameri
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Cardiology and Cardiovascular Medicine - Abstract
Aims The prevalence of occult left heart disease (LHD) and the feasibility of vasodilator therapy in the progressively growing population of elderly subjects with pulmonary arterial hypertension (PAH) are under scrutiny. We evaluated the presence of a LHD phenotype and the patterns of vasodilator treatment in such patients. Methods and results The PATRIARCA registry collected cross-sectional data from 180 subjects with PAH or chronic thromboembolic pulmonary hypertension and ≥70 years of age in 11 Italian centres between 1 December 2019 and 15 September 2020. After excluding patients with CTEPH or incomplete follow-up haemodynamic parameters, 77 individuals with PAH diagnosed at ≥ 65 years of age according to current guidelines were included in the analysis. A LHD phenotype was defined as follows, expanding the criteria adopted in the AMBITION trial: (i) ≥3 among body mass index ≥30 kg/m2, systemic hypertension, diabetes, and significant coronary artery disease; (ii) 2 of the risk factors for LHD above and ≥1 among permanent atrial fibrillation, left ventricular (LV) hypertrophy, LV ejection fraction Conclusions In this real-world cohort of elderly patients, a LHD phenotype was common despite an initial haemodynamic diagnosis of PAH. However, it did not appear to cause simplification or discontinuation of pulmonary vasodilator therapy. Longitudinal studies are needed to determine whether and how a LHD phenotype affects the use and effects of PAH drugs in the elderly.
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- 2021
14. Long-term outcome of patients with cardiolaminopathy undergoing defibrillator implantation: single-center experience
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Antonio Sanzo, Laura Scelsi, Eloisa Arbustini, A Vicentini, Claudia Raineri, Alessandra Serio, L.C Masiello, A Greco, Enrico Baldi, Roberto Rordorf, Annalisa Turco, Veronica Dusi, Simone Savastano, Barbara Petracci, and S Ghio
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medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,Single Center ,business ,Outcome (game theory) ,Surgery ,Term (time) - Abstract
Background Mutations in the LMNA gene are associated with a high arrhythmic risk. The history of the disease in patients undergoing ICD implantation is poorly characterized. Purpose To evaluate the phenotype of patients with cardiolaminopathy at the time of first ICD implantation, the incidence, characteristics and timing of ventricular arrhythmias (VAs) during follow up and the predictive value of the European score (that assigns a point each to non-sustained VT (NSVT), left ventricular ejection fraction (LVEF) Methods Patients were identified retrospectively. Clinical and device data were collected at baseline and during follow-up. Results We identified 26 patients (54% male, 42±8 years, 31% with familial history of sudden cardiac death, 31% with non-missense mutation) undergoing ICD implantation, 96% in primary prevention, 47% with single chamber ICD, 38% with dual chamber ICD. At the time of implantation, 30% had skeletal muscle involvement, 15% history of syncope, 4% of cardiac arrest, 62% previous NSVT. Also, 38% had a history of supraventricular arrhythmias and 61% had AV conduction disturbances. LVEF was 41±11%, 35% were in NYHA class ≥2, the mean European and Wahbi scores were 2.1±0.8 and 18.2±8.9, respectively. During 8.3±5 years, 15% were transplanted, 8% died due to HF, 4% underwent LVAD implantation, despite 31% having received an upgrade to CRT-D. Appropriate device interventions occurred in 46% of patients with a median time to first event of 29 months (IQR 13–93), for a total of 137 ATP, 51% of which effective (median 3ATP/patient, IQR 1–8) and of 26 shocks, 96% of which effective (median 2 shocks/patient, IQR 1–3); 12% had an arrhythmic storm. The first treated arrhythmia was a polymorphic VT/VF in 17%, a monomorphic VT in the others (medium cycle length 293±37 msec). Survival free from appropriate ICD interventions at 1 and at 5 years was 75% and 19% respectively in case of a European score ≥3 vs 94% and 82% in case of a score Conclusions Patients with cardiolaminopathy are at a high risk of both arrhythmic and heart failure progression over the first decade after implantation of the first ICD. A European score ≥3 identifies patients with 5-year shock/ATP free survival of less than 20% but does not predict death/transplantation. The first arrhythmic event in these patients is more frequently a rapid monomorphic VT with modest ATP efficacy. Funding Acknowledgement Type of funding sources: None.
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- 2021
15. Assessment of right ventricle in pulmonary arterial hypertension with three-dimensional echocardiography and cardiovascular magnetic resonance
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Marco Curti, Stefano Ghio, Maddalena Lattuada, Francesca Ceriani, Sergio Ghiringhelli, Andrea Bonelli, Chiara Giuntini, Annalisa Turco, Filippo Piacentino, Claudia Raineri, Laura Scelsi, Michele Golino, Mariangela Lattanzio, Fabrizio Morandi, Roberto De Ponti, and Massimo Venturini
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Male ,medicine.medical_specialty ,Comparative Effectiveness Research ,Heart Ventricles ,Echocardiography, Three-Dimensional ,Magnetic Resonance Imaging, Cine ,Walk Test ,Severity of Illness Index ,Natriuretic Peptide ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Ventricular Function ,Humans ,Pulmonary Arterial Hypertension ,medicine.diagnostic_test ,business.industry ,Walking test ,Brain ,Reproducibility of Results ,Magnetic resonance imaging ,Three dimensional echocardiography ,Stroke Volume ,General Medicine ,Plasma levels ,Female ,Middle Aged ,Peptide Fragments ,Prognosis ,Ventricular Function, Right ,Control subjects ,Magnetic Resonance Imaging ,Right ,medicine.anatomical_structure ,Echocardiography ,Cine ,Ventricle ,Three-Dimensional ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Clinical evaluation - Abstract
AIM To correlate 3-D Echo and CMR RV parameters and to verify whether they are similarly related to the clinical conditions of patients with pulmonary arterial hypertension (PAH), a disease in which the RV plays a crucial prognostic role. METHODS We enrolled 34 consecutive PAH patients followed by our PAH clinics. All patients underwent a 3-D Echo and CMR assessment of RV volumes and functions in the same day. The presence or absence of correlation between major findings was investigated; functional RV parameters were also analyzed in relation to 6-min walking test (6MWT) results and BNP/Nt-proBNP plasma levels. Twenty-four subjects served as controls. RESULTS Good agreement was found between 3-D Echo and CMR measures of RV volumes [RV-end-diastolic volume (r = 0.72, P
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- 2021
16. Long-term follow-up of heart transplant patients treated with permanent pacemaker: a monocentric study
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Eleonora Vullo, A Vicentini, Simone Savastano, Barbara Petracci, Annalisa Turco, Mauro Acquaro, S Ghio, Antonio Sanzo, S Pelenghi, L Oltrona Visconti, L Tua, L Vicini Scajola, Alessandra Greco, Laura Scelsi, and Roberto Rordorf
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Heart transplantation ,medicine.medical_specialty ,Long term follow up ,business.industry ,Surrogate endpoint ,medicine.medical_treatment ,Hemothorax ,medicine.disease ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,Transplant patient ,Systole ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block - Abstract
Funding Acknowledgements Type of funding sources: None. Background and purpose Permanent pacemaker implantation (PPMi) is needed in about 5% of patients following heart transplant (HTx) primarily due to sinus node dysfunction (SND), which commonly occurs in an early phase, or to atrio-ventricular block (ABV), which is common later on. Currently, data on rate of ventricular pacing (VP) is lacking and little is known on long-term outcomes after PPMi. Methods This was a retrospective, monocentric study. Among 1123 patients treated with HTx, all with biatrial technique, from november 1985 to march 2019 at our institution, 61 (5.4%) patients needed PPMi. PM parameters, clinical and echocardiographic data were collected at 1 month and at 1-3-5-10 years follow-up. The primary aim was to analyse the percentage of right ventricular pacing in the overall population and in subgroups stratified by the timing of PPMi and by pacing indication. Secondary endpoints were to analyze long-term outcomes according to the percentage of ventricular pacing and to the type of implanted PM (single vs. dual chamber). Results Among patients treated with PPMi (68.9% single-chamber), 62.2% were implanted for SND and 36% for AVB. Early PPMi (< 3 months after HTx), occurred in 34.4% of patients, mainly due to SND, while late PPMi (> 3 months after HTx) occurred in 65,6% with an equal distribution between SND and AVB. Median follow-up time from HTx was 140 months and 82 months from PPMi. Overall mean rate of VP was 21%. Rate of VP was higher in patients implanted early rather than late after HTx, both at 1 month (91% vs 2%, P = 0,002) and at 1 year after the procedure (43 vs 1, P = 0,037). Patients with AVB had a greater rate of VP compared to those implanted for SND, irrespective of timing of implantation and these findings were still present at 3 and 5 years follow-up (62 vs 1%, P = 0,011 at 3 years and 80 vs 6%, P = 0,002 at 5 years). VP declined progressively after PPM implantation. No differences were observed in terms of 10-years mortality between early vs late PPMi, dual vs single-chamber and mean VP > 21% vs ≤ 21%. Conclusions Patients treated with PPMi after HTx show on average low percentage of VP over long-term follow-up. AV block indication and early implantation are associated with a higher percentage of VP. The rate of VP, the timing of PPMi and the use of single vs dual chamber PM do not affect overall prognosis or left ventricular systolic function. Our data may justify implantation of a single-chamber PPM, which bears less complications and procedural time, in the majority of HTx patients needing PPMi.
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- 2021
17. Pulmonary hypertension and right ventricular remodeling in HFpEF and HFrEF
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Stefano Ghio, Laura Scelsi, Milika Asanin, Marija Polovina, Petar M. Seferovic, and Claudia Raineri
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medicine.medical_specialty ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Ventricular remodeling ,Heart Failure ,Ventricular Remodeling ,Ventricular function ,business.industry ,Stroke Volume ,Stroke volume ,Prognosis ,medicine.disease ,Pulmonary hypertension ,Pathophysiology ,medicine.anatomical_structure ,Ventricle ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Right ventricular function has long been neglected by heart failure specialists. We have now learnt that it is strongly associated with morbidity and mortality in all patients with heart failure, regardless of the degree of left ventricular dysfunction. Importantly, right ventricular function is tightly linked with pulmonary hypertension, and only a thorough understanding of how the right ventricle couples with the pulmonary circulation can provide an improved knowledge of the pathophysiology and possibly a more efficient treatment and a better prognosis in patients with heart failure.
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- 2019
18. Nonresponse to Acute Vasodilator Challenge and Prognosis in Heart Failure With Pulmonary Hypertension
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Andrea Garascia, Marco Guazzi, Daniele Masarone, Michele D'Alto, Pier Luigi Temporelli, Gabriele Crimi, Kavin Panneerselvam, Pietro Ameri, Ryan J. Tedford, Martina M. Moschella, Laura Scelsi, Mauro Rinaldi, Maria Teresa La Rovere, Matteo Marro, Stefano Ghio, Massimo Boffini, Giuseppe Pacileo, Luciana D'angelo, Claudio Montalto, Caterina Santolamazza, and Brian A. Houston
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medicine.medical_specialty ,Cardiac Catheterization ,left heart disease ,Pulmonary hypertension ,pulmonary vascular disease ,Hypertension, Pulmonary ,Vasodilator Agents ,Hemodynamics ,Vasodilation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Heart Failure ,business.industry ,medicine.disease ,Prognosis ,Compliance (physiology) ,Blood pressure ,medicine.anatomical_structure ,Heart failure ,Pulmonary artery ,Vascular resistance ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
An acute vasodilator challenge is recommended in patients with heart failure and pulmonary hypertension during heart transplant evaluation. The aim of the study was to assess which hemodynamic parameters are associated with nonresponsiveness to the challenge.This study is a retrospective analysis of 402 patients with heart failure with pulmonary hypertension who underwent right heart catheterization and a pulmonary vasodilator challenge. Among the 140 who fulfilled the transplant guidelines eligibility criteria for the vasodilator challenge, 38 were responders and 102 nonresponders. At multivariable analysis, a diastolic blood pressure of70 mm Hg, pulmonary vascular resistance of5 Woods units, and pulmonary artery compliance of1.2 mL/mm Hg were independently associated with poor response to vasodilator challenge (all P.001). The presence of any 2 of these 3 conditions was associated with a 90% probability of being a nonresponder. The covariate-adjusted hemodynamic predictors of death in the entire population were a low baseline systolic blood pressure (P = .0017) and a low baseline right ventricular stroke work index (P = .0395).In patients with heart failure and pulmonary hypertension, low pulmonary arterial compliance, high pulmonary vascular resistance, and low diastolic blood pressure predict the nonresponsiveness to acute vasodilator challenge whilst a poor right ventricular function predicts a dismal prognosis.
- Published
- 2021
19. Medical treatment of pulmonary hypertension in adults with congenital heart disease. updated and extended results from the International COMPERA-CHD registry
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Tobias J. Lange, Ekkehard Grünig, Heinrike Wilkens, Attila Nemes, Rainer Kozlik-Feldmann, Marius M. Hoeper, Peter Ewert, Katrin Milger, Matthias Held, Christian Apitz, Andris Skride, Michael Halank, Michael Hofbeck, Judith Löffler-Ragg, Martin Claussen, Hubert Wirtz, Dovile Jancauskaite, Leonhard Bruch, David Pittrow, Martin Koestenberger, Ralf Ewert, Anton Vonk Noordegraaf, Christine Pausch, Matthias Gorenflo, Dirk Skowasch, Stavros Konstantinides, Carmine Dario Vizza, Silvia Ulrich, Ingo Dähnert, Hossein Ardeschir Ghofrani, Eva Brunnemer, Marion Delcroix, Christian Jux, Rhoia Neidenbach, Hans Klose, Sebastian Freilinger, Dörte Huscher, Gerd Stähler, Laura Scelsi, Stephan Rosenkranz, Elena Jureviciene, Lina Gumbiene, Christian Opitz, Ann-Sophie Kaemmerer, Pulmonary medicine, and ACS - Pulmonary hypertension & thrombosis
- Subjects
congenital heart disease (CHD) ,eisenmenger syndrome ,pulmonary hypertension ,registry ,targeted treatment ,Pediatrics ,medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,Heart disease ,Eisenmenger syndrome ,GUIDELINES ,THERAPIES ,ANTICOAGULATION ,MANAGEMENT ,medicine ,EPIDEMIOLOGY ,cardiovascular diseases ,Science & Technology ,Medical treatment ,business.industry ,Congenital heart disease (CHD) ,medicine.disease ,Pulmonary hypertension ,ddc ,PREVALENCE ,Original Article on Current Management Aspects in Adult Congenital Heart Disease (ACHD): Part IV ,CLINICAL-ASPECTS ,Cardiovascular System & Cardiology ,ARTERIAL-HYPERTENSION ,Cardiology and Cardiovascular Medicine ,business ,Life Sciences & Biomedicine ,SINGLE-CENTER - Abstract
BACKGROUND: Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS: The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS: A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS: Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION: www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216. ispartof: CARDIOVASCULAR DIAGNOSIS AND THERAPY vol:11 issue:6 pages:1255-1268 ispartof: location:China status: published
- Published
- 2021
20. Risk stratification in patients with residual pulmonary hypertension after pulmonary endarterectomy
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Angelo Corsico, Catherine Klersy, Luigi Oltrona Visconti, Stefano Ghio, Andrea Maria D'Armini, Davide Piloni, Joice Masiglat, Ermelinda Borrelli, Laura Scelsi, Cristian Monterosso, Sofia Lucia Gamba, and Alessandra Greco
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Hypertension, Pulmonary ,Hemodynamics ,Endarterectomy ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Risk Assessment ,Pulmonary endarterectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,In patient ,030212 general & internal medicine ,business.industry ,medicine.disease ,Pulmonary hypertension ,Compliance (physiology) ,medicine.anatomical_structure ,Treatment Outcome ,Pulmonary artery ,Chronic Disease ,Vascular resistance ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
Background Few studies addressed the issue of risk stratification in patients with residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). This study tested the potential added value of parameters that have not been included in existing risk models. Methods We evaluated 546 consecutive patients with chronic thromboembolic pulmonary hypertension who underwent PEA and were followed-up for a median period of 58 months. Results Among the 242 with residual PH, 27 died and had 127 a clinical worsening event. At univariable analysis, the parameters associated with poor survival were pulmonary vascular resistance (PVR) ≥425 dyn·s·cm−5 (p ≤ 0.001), mean pulmonary artery pressure (mPAP) ≥38 mmHg (p = 0.003) and pulmonary artery compliance (CPA) ≤1.8 ml/mmHg (p = 0.014). In the bivariable models including either PVR or mPAP as first parameter, the addition of CPA was not statistically significant. The parameters associated with poor clinical worsening were CPA ≤1.8 ml/mmHg (p Conclusions Risk stratification in residual PH can be refined if CPA and PaO2 are considered in association with standard hemodynamic parameters.
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- 2020
21. Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry
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Elena Jureviciene, Marion Delcroix, David Pittrow, Werner Scholtz, Oliver Distler, Hans-Joachim Kabitz, Ralf Ewert, Karen M. Olsson, Gerry Coghlan, J. Simon R. Gibbs, Harald Kaemmerer, Elena Pfeuffer-Jovic, H. Ardeschir Ghofrani, Matthias Gorenflo, Martin Claussen, Dirk Skowasch, Tobias J. Lange, Hubert Wirtz, Ekkehard Grünig, Doerte Huscher, Nicola Benjamin, Leonhard Bruch, Christine Pausch, Katrin Milger, Anton Vonk-Noordegraaf, Heinrike Wilkens, Michael Halank, Andris Skride, Henning Gall, Juergen Behr, Laura Scelsi, Stephan Rosenkranz, Carmine Dario Vizza, Christian Opitz, Claus Neurohr, Marius M. Hoeper, Egle Paleviciute, Hans Klose, Silvia Ulrich, Daniel Dumitrescu, Iraklis Tsangaris, Lars Harbaum, Matthias Held, Gerd Staehler, and Skaidrius Miliauskas
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Male ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,0302 clinical medicine ,cluster ,mortality ,phenotypes ,pulmonary arterial hypertension ,survival ,Adult ,Aged ,Aged, 80 and over ,Cluster Analysis ,Europe ,Familial Primary Pulmonary Hypertension ,Female ,Follow-Up Studies ,Humans ,Lung ,Middle Aged ,Phenotype ,Prognosis ,Prospective Studies ,Pulmonary Wedge Pressure ,Survival Rate ,Registries ,DLCO ,80 and over ,education.field_of_study ,medicine.anatomical_structure ,Cardiology and Cardiovascular Medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Population ,03 medical and health sciences ,Diabetes mellitus ,Internal medicine ,medicine ,Lung transplantation ,education ,Transplantation ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,medicine.disease ,Pulmonary hypertension ,Obesity ,030228 respiratory system ,Surgery ,business - Abstract
The term idiopathic pulmonary arterial hypertension (IPAH) is used to categorize patients with pre-capillary pulmonary hypertension of unknown origin. There is considerable variability in the clinical presentation of these patients. Using data from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension, we performed a cluster analysis of 841 patients with IPAH based on age, sex, diffusion capacity of the lung for carbon monoxide (DLCO
- Published
- 2020
22. QTc Interval and Mortality in a Population of SARS-2-CoV Infected Patients
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Alessandro Vicentini, Lucrezia Masiello, Sabato D’Amore, Enrico Baldi, Stefano Ghio, Simone Savastano, Antonio Sanzo, Angela Di Matteo, Elena Maria Seminari, Marco Vincenzo Lenti, Matteo Bosio, Barbara Petracci, Laura Frigerio, Anna Sabena, Guido Tavazzi, Luigi Oltrona Visconti, Roberto Rordorf, Massimiliano Gnecchi, Rossana Totaro, Marco Ferlini, Alessandra Greco, Giulia Magrini, Laura Scelsi, Mauro Acquaro, Michela Coccia, Simonluca Digiacomo, Davide Foglia, Francesco Jeva, Claudio Montalto, Martina Moschella, Laura Pezza, Stefano Perlini, Claudia Alfano, Marco Bonzano, Federica Briganti, Giuseppe Crescenzi, Anna Giulia Falchi, Elena Maggi, Roberta Guarnone, Barbara Guglielmana, Ilaria Francesca Martino, Maria Serena Pioli Di Marco, Pietro Pettenazza, Federica Quaglia, Francesco Salinaro, Francesco Speciale, Ilaria Zunino, Giulia Sturniolo, Federico Bracchi, Elena Lago, Angelo Corsico, Davide Piloni, Giulia Accordino, Cecilia Burattini, Antonio Di Sabatino, Ivan Pellegrino, Simone Soriano, Giovanni Santacroce, Alessandro Parodi, Federica Borrelli de Andreis, Raffaele Bruno, Valentina Zuccaro, Francesco Moioli, Valentino Dammassi, and Riccardo Albertini
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Male ,medicine.medical_specialty ,Time Factors ,Population ,Action Potentials ,medicine.disease_cause ,QT interval ,Risk Assessment ,Electrocardiography ,Heart Conduction System ,Heart Rate ,Risk Factors ,Physiology (medical) ,Internal medicine ,Heart rate ,medicine ,Humans ,education ,Coronavirus ,Aged ,Retrospective Studies ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,COVID-19 ,Retrospective cohort study ,Atrial fibrillation ,Arrhythmias, Cardiac ,Middle Aged ,medicine.disease ,Prognosis ,Hospitalization ,Italy ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Published
- 2020
23. Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension
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Carlo Lombardi, Michele D'Alto, Amresh Raina, Marco Confalonieri, Paola Argiento, Michele Correale, Giuseppe Paciocco, Marco Corda, Massimiliano Mulè, Susanna Sciomer, Laura Scelsi, Carmine Dario Vizza, Raymond L. Benza, Roberto Poscia, Roberto Badagliacca, Stefano Ghio, Badagliacca, Roberto, Raina, Amresh, Ghio, Stefano, D'Alto, Michele, Confalonieri, Marco, Correale, Michele, Corda, Marco, Paciocco, Giuseppe, Lombardi, Carlo, Mulã, Massimiliano, Poscia, Roberto, Scelsi, Laura, Argiento, Paola, Sciomer, Susanna, Benza, Raymond L., and Vizza, Carmine Dario
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right ventricular morphology ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Right ventricular morphology ,Combination therapy ,Heart Ventricles ,Right ventricular systolic function ,Hemodynamics ,030204 cardiovascular system & hematology ,Pulmonary arterial hypertension ,right ventricular systolic function ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,pulmonary arterial hypertension ,Internal medicine ,Ventricular morphology ,medicine ,Humans ,Familial Primary Pulmonary Hypertension ,In patient ,echocardiography ,upfront therapy ,surgery ,pulmonary and respiratory medicine ,cardiology and cardiovascular medicine ,transplantation ,Retrospective Studies ,Transplantation ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,Prostanoid ,Middle Aged ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,chemistry ,Echocardiography ,Vascular resistance ,Cardiology ,Drug Therapy, Combination ,Female ,Upfront therapy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies. Methods Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters. Results At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively. Conclusions In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.
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- 2018
24. Haemodynamic effects of an acute vasodilator challenge in heart failure patients with reduced ejection fraction and different forms of post-capillary pulmonary hypertension
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Marco Guazzi, Maria Teresa La Rovere, Gabriele Crimi, Luigi Oltrona Visconti, Claudia Raineri, Stefano Ghio, Antonia Cannito, Laura Scelsi, Dario Vizza, Pier Luigi Temporelli, and Egidio Traversi
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Vascular disease ,Diastole ,Hemodynamics ,Stroke volume ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Vascular resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims The most recent European guidelines have proposed new definitions of pulmonary hypertension (PH) in left heart disease, to better approach the characteristics required to reflect the presence of pulmonary vascular disease. The purpose of this study was to assess whether different haemodynamic definitions of post-capillary PH imply a different reversibility of PH in response to acute vasodilator administration in heart failure patients with reduced ejection fraction and PH (HFrEF-PH). Methods and results Right heart catheterization and reversibility testing was performed in 156 HFrEF-PH patients. Patients were classified as combined post-capillary and pre-capillary pulmonary hypertension (Cpc-PH) vs. isolated post-capillary pulmonary hypertension (Ipc-PH) and on the basis of diastolic pulmonary gradient (DPG) ≥ 7 vs. 12 vs. ≤12 mmHg. After vasodilator administration, Cpc-PH patients showed a greater per cent improvement in pulmonary vascular resistance (PVR), DPG and TPG as compared with Ipc-PH patients (all Pint 12 mmHg groups (28.3, 26.7 and 18.9%, respectively). Conclusion Although substantial improvements in PVR, DPG and TPG were observed in Cpc-PH patients after acute vasodilator administration, this response was associated with persistent abnormalities in the PVR vs. PCa relationship. The link between baseline right heart haemodynamics and pulmonary vascular disease remains elusive.
- Published
- 2017
25. Out-of-hospital cardiac arrest in patients with heart disease from family members’ perspective: high perception of risk, low sense of adequacy and the importance of training
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Luigi Oltrona Visconti, Annalisa Turco, Stefano Ghio, Laura Scelsi, Sara Compagnoni, Alessandra Greco, Enrico Baldi, Francesca Romana Gentile, and Simone Savastano
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Family Health ,medicine.medical_specialty ,Heart Diseases ,Heart disease ,business.industry ,Perspective (graphical) ,General Medicine ,medicine.disease ,Risk Assessment ,Cardiopulmonary Resuscitation ,Out of hospital cardiac arrest ,Risk perception ,Italy ,Humans ,Medicine ,Family ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Attitude to Health ,Health Education ,Needs Assessment ,Out-of-Hospital Cardiac Arrest - Published
- 2021
26. ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism
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Michele Massimo Gulizia, Franco Casazza, Giuseppe Favretto, Andrea Maria D'Armini, Antonella Tufano, Valentina Grazioli, Carlo D'Agostino, Nicoletta Corrieri, Cecilia Becattini, Gualtiero Palareti, Loris Roncon, Michele D'Alto, Amedeo Bongarzoni, Pietro Zonzin, Giovanni Di Minno, Iolanda Enea, Piergiuseppe Agostoni, Laura Scelsi, Maria Grazia De Natale, Lucia Filippi, Michele Azzarito, Francesca Bux, Nicola D’Amato, Walter Ageno, Raffaele Pesavento, D'Agostino, DIEGO CARLO, Zonzin, Pietro, Enea, Iolanda, Gulizia, Michele Massimo, Ageno, Walter, Agostoni, Piergiuseppe, Azzarito, Michele, Becattini, Cecilia, Bongarzoni, Amedeo, Bux, Francesca, Casazza, Franco, Corrieri, Nicoletta, D'Alto, Michele, D'Amato, Nicola, D'Armini, Andrea Maria, De Natale, Maria Grazia, Di Minno, Giovanni, Favretto, Giuseppe, Filippi, Lucia, Grazioli, Valentina, Palareti, Gualtiero, Pesavento, Raffaele, Roncon, Lori, Scelsi, Laura, and Tufano, Antonella
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medicine.medical_specialty ,Prognosi ,Long term follow up ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Deep vein thrombosi ,Deep vein thrombosis ,Consensus document ,Prognosis ,Pulmonary embolism ,Treatment ,Venous thromboembolism ,medicine ,030212 general & internal medicine ,cardiovascular diseases ,Intensive care medicine ,business.industry ,Articles ,medicine.disease ,equipment and supplies ,Venous thrombosis ,Position paper ,Chronic thromboembolic pulmonary hypertension ,Occult cancer ,Cardiology and Cardiovascular Medicine ,business - Abstract
Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.
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- 2017
27. P5416A single-center, thirty-year experience of heart transplantation: analysis of the evolution of patients profile and long term outcomes
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Annalisa Turco, Claudia Raineri, Elena Seminari, M Riccardi, S Ghio, Andrea Maria D'Armini, P Totaro, Carlo Pellegrini, Laura Scelsi, Barbara Cattadori, S Pelenghi, A. Di Matteo, L Oltrona Visconti, Stefania Guida, and Rita Camporotondo
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Heart transplantation ,Pediatrics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Long term outcomes ,Medicine ,Cardiology and Cardiovascular Medicine ,Single Center ,business - Abstract
Background Heart Transplantation is still the gold standard therapy for patients suffering from end-stage cardiomyopathy and has been successfully performed in our center since 1985. Over this 30 years period there has been a significant evolution in patients characteristics and in candidate selection (either as a donor and as recipient) as shown by the recent benchmark from International Society of Heart and Lung Transplantation (ISHLT). Here we analyze the evolution of patients profile in our population and we correlated such evolution to the clinical outcomes and to the overall data from ISHLT. Materials and methods Overall 1122 patients underwent heart transplantation at our center from November 19th1985 to date. To analyze the evolution patients profile and donor criteria, patient population was divided in 4 groups according era of transplantation following ISHLT model (Group A from 1985 to 1991; Group B from 1992 to 2003; Group C from 2004 to 2008 and Group D from 2009 to date). Patients characteristics at time of transplantation, donor criteria ad clinical outcomes were analyzed and compared within 4 groups. An overall comparison of our results to the data from ISHLT was also performed. Results Overall Kaplan-Meier survival curve correlates favourably with ISHLT data showing a 20 years survival approaching 40%. Patients age at transplantation changed significantly among 4 groups from a median of 49 years (95% CI 47 to 51) in Group A to 54 years (95% CI 50 to 57) in Group D (p Figure 1 Conclusions The significant changing characteristics of both recipients and donors, over 30 years of activity, had a significant impact in early (1 year) postoperative survival following heart transplantation. Although medium/long term outcomes are still satisfactory in patients surviving at least 1 year, these data clearly suggest a more accurate patients selection and the need of alternative treatment before patients conditions deteriorate while on waiting list for heart transplantation
- Published
- 2019
28. P5554Follow the light - The prognostic value of late gadolinium enhancement in hypertrophic cardiomyopathy
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Filippo Angelini, Claudia Raineri, Federico Fortuni, S Leonardi, Gabriele Crimi, G M De Ferrari, S Ghio, L Oltrona Visconti, Raffaele Abete, Annalisa Turco, and Laura Scelsi
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medicine.medical_specialty ,business.industry ,Gadolinium ,Hypertrophic cardiomyopathy ,Cardiomyopathy ,chemistry.chemical_element ,medicine.disease ,Implantable defibrillators ,Sudden cardiac death ,chemistry ,Primary prevention ,Internal medicine ,Cardiology ,Medicine ,Late gadolinium enhancement ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and aim Hypertrophic cardiomyopathy (HCM) is a genetic based cardiomyopathy with heterogeneous phenotypic expression. Since it is one of the most common cause of sudden cardiac death (SCD) in the young different risk score have been proposed to properly identify the patients that would benefit from a primary prevention with an implantable cardioverter-defibrillator (ICD). ESC guidelines on HCM suggest to estimate the risk of SCD considering clinical and echocardiographic parameters and mention the use of cardiac magnetic resonance (CMR) only in the case of poor echo windows. The aim of the present study-level meta-analysis was to explore the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for adverse fatal events. Methods We searched PubMed and EMBASE for studies that investigated the prognostic value of LGE in patients with HCM. The outcomes of interest were SCD or aborted SCD, all-cause mortality and cardiovascular (CV) mortality. Random-effects Odds Ratios (ORs) were estimated using a DerSimonian-Laird method with a person-year approach. Moreover, an univariate meta-regression was performed to assess the moderator effect of mean age, LGE % of left ventricle (LV) and gender (expressed as male percentage). Results A total of 7 studies (n=3351) were included in the analysis. Mean follow-up was 3±0.63 years. Mean age was 47.7±14.6 years and 56.9% were male. LGE was detected in 1845 (55%) patients with a mean LGE percentage of LV of 7%. The presence of LGE was associated with an increased incidence of SCD or aborted SCD (OR 3.44; 95% CI 2.02–5.86; p Prognostic value of LGE for SCD Conclusions The presence of LGE at CMR in patients with HCM exhibited a substantial prognostic value in fatal events and, in particular, in the prediction of SCD. LGE assessment is an effective tool to stratify the arrhythmic risk in HCM. Therefore, it should be considered, especially in borderline cases, to improve the identification of HCM patients who could benefit from ICD implantation.
- Published
- 2019
29. Identifying potential parameters associated with response to switching from a PDE5i to riociguat in RESPITE
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Pavel Jansa, James R. Klinger, Dennis Busse, Gérald Simonneau, Stephan Rosenkranz, David Langleben, Raymond L. Benza, Christian Meier, Hossein Ardeschir Ghofrani, Marius M. Hoeper, Amresh Raina, Laura Scelsi, Robert Naeije, Thenappan Thenappan, and Paul A. Corris
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Cardiac function curve ,medicine.medical_specialty ,Hypertension, Pulmonary ,Hemodynamics ,Pilot Projects ,030204 cardiovascular system & hematology ,Pulmonary arterial hypertension ,Riociguat ,03 medical and health sciences ,0302 clinical medicine ,Physiologie générale ,Respite care ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,030212 general & internal medicine ,Pulmonary hemodynamics ,business.industry ,Stroke volume ,Phosphodiesterase 5 Inhibitors ,Brain natriuretic peptide ,medicine.anatomical_structure ,Pyrimidines ,Vascular resistance ,Cardiology ,Switching to riociguat ,Pyrazoles ,Right heart function ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,medicine.drug - Abstract
Background: RESPITE evaluated patients with pulmonary arterial hypertension and an inadequate response to phosphodiesterase type 5 inhibitors (PDE5i) who switched to riociguat. This post hoc analysis assessed response to this switch in parameters associated with clinical improvement. Methods: RESPITE was a 24-week, uncontrolled pilot study (n = 61). Differences in functional, hemodynamic, and cardiac function parameters, REVEAL risk score (RRS), and biomarkers were compared between responders (free from clinical worsening, World Health Organization functional class I/II, and ≥30 m improvement in 6-min walking distance at Week 24) and non-responders. Results: Of 51 patients (84%) completing RESPITE, 16 (31%) met the responder endpoint. At baseline, there were significant differences between responders and non-responders in N-terminal prohormone of brain natriuretic peptide (NT-proBNP), growth/differentiation factor 15 (GDF-15), and RRS, whereas there were no differences in hemodynamics or cardiac function. At Week 24, responders had significant improvements in pulmonary arterial compliance, pulmonary vascular resistance, and mean pulmonary arterial pressure, while non-responders showed no significant change. Cardiac efficiency and stroke volume index significantly improved irrespective of responder status. Conclusions: NT-proBNP, GDF-15, and RRS were identified as potential predictors of response in patients switching from PDE5i to riociguat. Further prospective controlled studies are needed to confirm the association of these parameters with response., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2019
30. Right ventricular recovery during follow-up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction
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Claudia Raineri, Anca Simioniuc, Andrea Rossi, Gianpaolo Reboldi, Luna Gargani, Erberto Carluccio, Giulia Elena Mandoli, Laura Scelsi, Stefano Ghio, Antonia Cannito, Paolo Biagioli, Gian Giacomo Galeotti, Frank Lloyd Dini, and Pier Luigi Temporelli
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,Proportional hazards model ,Hazard ratio ,Improved survival ,Systolic function ,030204 cardiovascular system & hematology ,medicine.disease ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Heart failure ,Cardiology ,medicine ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS A compromised tricuspid annular plane systolic excursion (TAPSE) is associated with worse survival in patients with chronic heart failure with reduced ejection fraction (HFrEF). However, it is not known whether a reversible abnormal TAPSE at follow-up predicts survival. Our aim was to evaluate whether a reversible abnormal TAPSE is associated with a better survival in patients with chronic HFrEF. METHODS AND RESULTS A complete echocardiography was performed in 706 patients with chronic HFrEF (LVEF ≤45%) at baseline and after 6 ± 3 months. Right ventricular (RV) systolic function was evaluated using TAPSE. The study endpoint was all-cause mortality. At baseline, TAPSE was severely reduced (≤14 mm) in 89 (13%) patients, and slightly reduced (>14 but
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- 2016
31. Genetic Screening of Anderson-Fabry Disease in Probands Referred From Multispecialty Clinics
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Claudio Rapezzi, Eloisa Arbustini, Manuela Agozzino, Maurizio Melis, Filippo Mangione, Annarita Colucci, Alexandra Smirnova, Riccardo Borroni, Elena Biagini, M Molinaro, Jagat Narula, Maurizia Rasura, Valentina Favalli, Alessandra Serio, Nupoor Narula, Antonello Ganau, Daniela Concolino, Maria Teresa Di Mascio, Antonia Nucera, GianPietro Sechi, Clelia Caspani, Camilla Vassallo, Carlo Pellegrini, Eliana Disabella, Umberto Scoditti, Marilena Tagliani, Calogero Giordano, Pamela Cassini, Massimiliano Marini, Carmela Giorgianni, Elena Antoniazzi, Anna Scarabotto, Donata Guidetti, Takahide Kodama, Marina Diomedi, Michelangelo Mancuso, Danilo Toni, Marialuisa Zedde, Luigi Tavazzi, Maurizia Grasso, Laura Scelsi, Lorenzo Giuliani, Laura Fancellu, Stefania Piga, Monica Concardi, Stefano Ghio, Favalli, Valentina, Disabella, Eliana, Molinaro, Mariadelfina, Tagliani, Marilena, Scarabotto, Anna, Serio, Alessandra, Grasso, Maurizia, Narula, Nupoor, Giorgianni, Carmela, Caspani, Clelia, Concardi, Monica, Agozzino, Manuela, Giordano, Calogero, Smirnova, Alexandra, Kodama, Takahide, Giuliani, Lorenzo, Antoniazzi, Elena, Borroni, Riccardo G, Vassallo, Camilla, Mangione, Filippo, Scelsi, Laura, Ghio, Stefano, Pellegrini, Carlo, Zedde, Marialuisa, Fancellu, Laura, Sechi, Gianpietro, Ganau, Antonello, Piga, Stefania, Colucci, Annarita, Concolino, Daniela, Di Mascio, Maria Teresa, Toni, Danilo, Diomedi, Marina, Rapezzi, Claudio, Biagini, Elena, Marini, MASSIMILIANO LUIGI IVO, Rasura, Maurizia, Melis, Maurizio, Nucera, Antonia, Guidetti, Donata, Mancuso, Michelangelo, Scoditti, Umberto, Cassini, Pamela, Narula, Jagat, Tavazzi, Luigi, and Arbustini, Eloisa
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Adult ,Male ,Proband ,GLA ,MOGE(S) classification ,biochemical ,family screening ,multidisciplinary evaluation ,α-Gal ,Pediatrics ,medicine.medical_specialty ,Pathology ,Adolescent ,Disease ,030204 cardiovascular system & hematology ,NO ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Lysosomal storage disease ,Humans ,Genetic Testing ,Prospective Studies ,Child ,Prospective cohort study ,Genetic testing ,Alpha-galactosidase ,biology ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Fabry disease ,Hospitals ,3. Good health ,Anderson-Fabry Disease ,Settore MED/03 - Genetica Medica ,alpha-Galactosidase ,Mutation ,biology.protein ,Fabry Disease ,Medicine ,Female ,Settore MED/26 - Neurologia ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Anderson-Fabry disease (AFD) is a rare X-linked lysosomal storage disease, caused by defects of the alpha-galactosidase A (GLA) gene. AFD can affect the heart, brain, kidney, eye, skin, peripheral nerves, and gastrointestinal tract. Cardiology (hypertrophic cardiomyopathy), neurology (cryptogenic stroke), and nephrology (end-stage renal failure) screening studies suggest the prevalence of GLA variants is 0.62%, with diagnosis confirmation in 0.12%. OBJECTIVES: This study sought to expand screening from these settings to include ophthalmology, dermatology, gastroenterology, internal medicine, pediatrics, and medical genetics to increase diagnostic yield and comprehensively evaluate organ involvement in AFD patients. METHODS: In a 10-year prospective multidisciplinary, multicenter study, we expanded clinical, genetic, and biochemical screening to consecutive patients enrolled from all aforementioned clinical settings. We tested the GLA gene and α-galactosidase A activity in plasma and leukocytes. Inclusion criteria comprised phenotypical traits and absence of male-to-male transmission. Screening was extended to relatives of probands harboring GLA mutations. RESULTS: Of 2,034 probands fulfilling inclusion criteria, 37 (1.8%) were carriers of GLA mutations. Cascade family screening identified 60 affected relatives; clinical data were available for 4 affected obligate carriers. Activity of α-galactosidase A in plasma and leukocytes was diagnostic in male subjects, but not in female subjects. Of the 101 family members harboring mutations, 86 were affected, 10 were young healthy carriers, and 5 refused clinical evaluation. In the 86 patients, involved organs or organ systems included the heart (69%), peripheral nerves (46%), kidney (45%), eye (37%), brain (34%), skin (32%), gastrointestinal tract (31%), and auditory system (19%). Globotriaosylceramide accumulated in organ-specific and non-organ-specific cells in atypical and classic variants, respectively. CONCLUSIONS: Screening probands with clinically suspected AFD significantly increased diagnostic yield. The heart was the organ most commonly involved, independent of the clinical setting in which the patient was first evaluated. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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- 2016
32. P2867Late gadolinium enhancement at cardiac magnetic resonance accurately predicts arrhythmias in patients with non-ischemic cardiomyopathy
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Barbara Petracci, Claudia Raineri, A Vicentini, Claudia Pavesi, Antonio Sanzo, Adele Valentini, S Ghio, L Oltrona Visconti, Roberto Rordorf, Simone Savastano, Laura Scelsi, G M De Ferrari, Emilio Maria Bassi, Veronica Dusi, and Annalisa Turco
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medicine.medical_specialty ,chemistry ,business.industry ,Internal medicine ,Gadolinium ,Non ischemic cardiomyopathy ,Cardiology ,medicine ,chemistry.chemical_element ,In patient ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business - Published
- 2018
33. P4535Right ventricular response to stress in pulmonary arterial hypertension
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Claudia Raineri, Stefania Guida, Laura Scelsi, Roberto Badagliacca, Benedetta Matrone, S Ghio, Eleonora Vullo, L Oltrona Visconti, Federico Fortuni, Carlo Lombardi, and Annalisa Turco
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Stress (mechanics) ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
34. P297Cardiac sympathetic denervation: evolving technique, expanding indications
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Laura Scelsi, Claudia Raineri, A. Mori, Simone Savastano, Luigi Pugliese, Roberto Rordorf, Federica Dagradi, S Ghio, G M De Ferrari, Rita Camporotondo, Lia Crotti, P J Schwartz, Veronica Dusi, Silvia Castelletti, and A Vicentini
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Sympathetic Denervation ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Internal medicine ,Cardiology ,Medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
35. Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry
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Cristina Giannattasio, Riccardo Mantovani, Aurelia Grosu, Giovanni Battista Perego, Paola Sormani, Antonello Gavazzi, Giovanni Peretto, Daniele Briguglia, Marisa Varrenti, Marco Metra, Carlo Campana, Maria Frigerio, Stefania Colombo, Claudia Raineri, Jeness Campodonico, Salvatore I. Caico, Carlo Lombardi, Silvia Guglielmetto, Manlio Cipriani, Daniela Pini, Enrico Ammirati, Fabrizio Oliva, Fabrizio Morandi, Michele Senni, Piergiuseppe Agostoni, Claudio Moro, A. Ciro, Armando Belloni, Laura Scelsi, Valentina Carubelli, Andrea Mortara, Annalisa Turco, Paolo G. Camici, Patrizia Pedrotti, Antonio Mafrici, Cristina Conca, Alberto Maestroni, Giuseppe Di Tano, Ammirati, E, Cipriani, M, Moro, C, Raineri, C, Pini, D, Sormani, P, Mantovani, R, Varrenti, M, Pedrotti, P, Conca, C, Mafrici, A, Grosu, A, Briguglia, D, Guglielmetto, S, Battista Perego, G, Colombo, S, Caico, S, Giannattasio, C, Maestroni, A, Carubelli, V, Metra, M, Lombardi, C, Campodonico, J, Agostoni, P, Peretto, G, Scelsi, L, Turco, A, Di Tano, G, Campana, C, Belloni, A, Morandi, F, Mortara, A, Cirò, A, Senni, M, Gavazzi, A, Frigerio, M, Oliva, F, and Camici, P
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Biopsy ,Myocarditi ,030204 cardiovascular system & hematology ,Outcome (game theory) ,cardiac magnetic resonance ,Ventricular Function, Left ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Acute myocarditi ,medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Registries ,Aged ,Retrospective Studies ,business.industry ,Cardiovascular Agents ,Stroke Volume ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Middle Aged ,Magnetic Resonance Imaging ,Troponin ,Hospitalization ,Myocarditis ,Acute myocarditis ,Treatment Outcome ,Italy ,Cohort ,endomyocardial biopsy ,Acute Disease ,outcome ,Heart Transplantation ,Female ,Presentation (obstetrics) ,heart transplantation ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals. Methods: A total of 684 patients with suspected AM and recent onset of symptoms (70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance. Results: At presentation, 118 patients (26.6%) had left ventricular ejection fraction P P P =0.18). After a median time of 196 days, 200 patients had follow-up cardiac magnetic resonance, and 8 of 55 (14.5%) with complications at presentation had left ventricular ejection fraction Conclusions: In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction
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- 2018
36. Dobutamine stress echocardiography in pulmonary arterial hypertension
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Roberto Badagliacca, Stefano Ghio, Claudia Raineri, Federico Fortuni, Eleonora Vullo, Carlo Lombardi, Annalisa Turco, Benedetta Matrone, Alessandra Greco, Laura Scelsi, Luigi Oltrona Visconti, and Stefania Guida
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Adult ,Male ,medicine.medical_specialty ,Cardiac output ,Dobutamine stress echocardiography ,Hypertension, Pulmonary ,Area change ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Pulmonary arterial hypertension ,03 medical and health sciences ,0302 clinical medicine ,contractility reserve ,pulmonary arterial hypertension ,right ventricle ,adult ,aged ,dobutamine ,echocardiography, doppler, color ,echocardiography, stress ,exercise test ,female ,humans ,hypertension, pulmonary ,male ,middle aged ,tricuspid valve insufficiency ,Dobutamine ,Internal medicine ,medicine.artery ,Heart rate ,medicine ,Humans ,In patient ,cardiovascular diseases ,Aged ,Contractility reserve ,Right ventricle ,Cardiology and Cardiovascular Medicine ,business.industry ,Middle Aged ,Tricuspid Valve Insufficiency ,Echocardiography, Doppler, Color ,030228 respiratory system ,Pulmonary artery ,Exercise Test ,cardiovascular system ,Cardiology ,Female ,sense organs ,business ,Echocardiography, Stress ,medicine.drug - Abstract
Background There is a growing interest in exploring the concept of right ventricular functional reserve in patients with pulmonary arterial hypertension. However, it is still unclear how it should be assessed. Aim of the study was to investigate the determinants of the changes in cardiac output and in pulmonary pressure during dobutamine stress echocardiography in pulmonary arterial hypertension. Methods Low-dose dobutamine stress echocardiography was performed in 55 patients and 28 controls. Tricuspid annular plane systolic excursion, its ratio to systolic pulmonary artery pressure, right ventricular area change, degree of tricuspid regurgitation, right ventricular end-systolic pressure-area ratio, cardiac output were assessed at rest and at peak stress. Results According to the stress induced increase in cardiac output, patients were classified into 2 groups: above/equal to the median of 2.8 L/min (high cardiac output) or below the median (low cardiac output). High cardiac output patients were characterized by a greater increase in heart rate (+45.1 ± 17.5 vs +21.3 ± 17.7 bpm), a greater improvement in tricuspid annular plane systolic excursion (+4.2 ± 3.3 vs +1.9 ± 2.6 mm, P = 0.005) and a decrease in tricuspid regurgitation (P = 0.010) as compared to low cardiac output patients. Changes in pulmonary pressure were not associated with changes in indicators of right ventricular function but only with changes in heart rate. Conclusions The increase in cardiac output during dobutamine is associated with an improvement in longitudinal right ventricular function, a decrease in tricuspid regurgitation and an increase in heart rate. Changes in pulmonary pressure only reflect the changes in heart rate.
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- 2018
37. Modes of death and prognostic outliers in chronic heart failure
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Andrea Passantino, Valentina Milani, Gian Luigi Nicolosi, Roberto Latini, Aldo Pietro Maggioni, Francesca Olmetti, Nina Ajmone Marsan, Maria Teresa La Rovere, Rosa Raimondo, Ugo Corrà, Domenico Scrutinio, LUIGI TAVAZZI, Pietro Ameri, and Laura Scelsi
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Male ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Risk Assessment ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cause of Death ,medicine ,Humans ,030212 general & internal medicine ,education ,Cause of death ,Aged ,Probability ,Heart Failure ,education.field_of_study ,Framingham Risk Score ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Incidence ,Stroke Volume ,medicine.disease ,Prognosis ,Death, Sudden, Cardiac ,Heart failure ,Area Under Curve ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers.The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability14%) vs. in 23.5% of the high-risk ones (N = 375 with probability56%, P.0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P.0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure.The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
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- 2018
38. Anticoagulation and Survival in Pulmonary Arterial Hypertension Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)
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Laura Scelsi, Michael Halank, David Pittrow, Matthias Gorenflo, Rudolf Speich, Karen M. Olsson, Hans Klose, Ralf Ewert, Gerry Coghlan, Gerd Staehler, J. Simon R. Gibbs, Stephan Rosenkranz, Juergen Behr, Anton Vonk-Noordegraaf, Martin Claussen, Joanna Pepke-Zaba, Marius M. Hoeper, Uwe Schulz, Doerte Huscher, C. Dario Vizza, Christian Opitz, Marion Delcroix, Henning Tiede, Harald Kaemmerer, H. Ardeschir Ghofrani, Tobias J. Lange, Ekkehard Grünig, Matthias Held, Pulmonary medicine, and ICaR - Heartfailure and pulmonary arterial hypertension
- Subjects
medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,Idiopathic Pulmonary Arterial Hypertension ,Medicine ,In patient ,Newly diagnosed ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,medicine.disease ,Pulmonary hypertension - Abstract
Background— For almost 30 years, anticoagulation has been recommended for patients with idiopathic pulmonary arterial hypertension (IPAH). Supporting evidence, however, is limited, and it is unclear whether this recommendation is still justified in the modern management era and whether it should be extended to patients with other forms of pulmonary arterial hypertension (PAH). Methods and Results— We analyzed data from Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA), an ongoing European pulmonary hypertension registry. Survival rates of patients with IPAH and other forms of PAH were compared by the use of anticoagulation. The sample consisted of 1283 consecutively enrolled patients with newly diagnosed PAH. Anticoagulation was used in 66% of 800 patients with IPAH and in 43% of 483 patients with other forms of PAH. In patients with IPAH, there was a significantly better 3-year survival ( P =0.006) in patients on anticoagulation compared with patients who never received anticoagulation, albeit the patients in the anticoagulation group had more severe disease at baseline. The survival difference at 3 years remained statistically significant ( P =0.017) in a matched-pair analysis of n=336 IPAH patients. The beneficial effect of anticoagulation on survival of IPAH patients was confirmed by Cox multivariable regression analysis (hazard ratio, 0.79; 95% confidence interval, 0.66–0.94). In contrast, the use of anticoagulants was not associated with a survival benefit in patients with other forms of PAH. Conclusions— The present data suggest that the use of anticoagulation is associated with a survival benefit in patients with IPAH, supporting current treatment recommendations. The evidence remains inconclusive for other forms of PAH. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01347216.
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- 2014
39. Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension
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Emanuele Romeo, Patrizio Vitulo, Laura Scelsi, Roberto Poscia, Roberto Badagliacca, Corrado Tamburino, Stefano Ghio, Lavinia Martino, Fabio Tuzzolino, Paola Argiento, Massimiliano Mulè, Claudia Raineri, Carmine Dario Vizza, and Michele D'Alto
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,Hypertension, Pulmonary ,Hemodynamics ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Pulmonary arterial hypertension ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Right heart hemodynamics ,Internal medicine ,medicine.artery ,Medicine ,Humans ,medicine (all) ,Cardiac catheterization ,Aged ,business.industry ,Pulmonary ,Middle Aged ,medicine.disease ,Prognosis ,Pulmonary hypertension ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,ROC Curve ,prognosis ,pulmonary arterial hypertension ,right heart hemodynamics ,cardiology and cardiovascular medicine ,Hypertension ,Cohort ,Pulmonary artery ,Etiology ,Vascular resistance ,Cardiology ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background Conventional hemodynamic parameters are considered to be the gold standard indices of outcome in pulmonary arterial hypertension (PAH); on the contrary, few data support the hypothesis that the pulsatile component of right ventricular afterload provides important prognostic information. The aim of the study was to investigate the prognostic significance of pulmonary arterial compliance (PCa) after therapy initiation or escalation in PAH patients. Methods A cohort of 419 consecutive PAH patients (308 naive and 111 prevalent) underwent right heart catheterisation (RHC) prior to initiating or escalating PAH-targeted therapy. RHC was repeated in 255 patients (61%) after 4 to 12months of therapy as 62 patients (15%) died and 102 (24%) did not undergo a follow-up RHC within the first year. Results After the follow-up RHC, 63 patients died over a median follow-up period of 39months. At multivariate analysis, age>50years old, male gender, etiology associated with systemic sclerosis, persistence of WHO class III/IV, and reduced PCa at follow-up RHC were the independent parameters significantly associated with poor prognosis. At ROC analysis, the optimal cut-off point of PCa to predict survival was 1.4mL/mmHg (AUC 0.73, sensitivity 81.8%, specificity 58.8%). Conclusions In PAH patients hospitalized to initiate or to escalate PAH-specific therapy, failure to improve PCa after therapy is a strong hemodynamic predictor of poor prognosis.
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- 2016
40. Pulmonary hypertension and right ventricular dysfunction in left heart disease (group 2 pulmonary hypertension)
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Evelyn M. Horn, Laura Scelsi, Stefano Ghio, and Sean Wilson
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Diagnostic Imaging ,medicine.medical_specialty ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Severity of Illness Index ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Humans ,Pulmonary Wedge Pressure ,Pulmonary wedge pressure ,Ejection fraction ,business.industry ,Mitral valve replacement ,Stroke Volume ,Stroke volume ,Prognosis ,medicine.disease ,Pulmonary hypertension ,medicine.anatomical_structure ,cardiovascular system ,Vascular resistance ,Cardiology ,Ventricular pressure ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business - Abstract
Group 2 pulmonary hypertension is most frequently caused by left heart disease, a heterogeneous set of disorders. These processes include left ventricular systolic dysfunction, left ventricular dysfunction with preserved ejection fraction and valvular (mitral and/or aortic) diseases. Left heart disease may cause passive backward transmission of pressure leading to elevated left atrial and pulmonary arterial pressures due to a myriad of processes. Increasingly, it has been recognized that some patients may develop pulmonary arterial pressure out of proportion from what is expected. This is believed to be due to increases in vasomotor tone and/or vascular remodeling. Over time patients may go on to develop progressive right ventricular dysfunction, a marker for poor prognosis. This review will explore the different characteristics of these conditions including the incidence, pathophysiology, clinical implications, prognosis and current state of available medical therapies.
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- 2012
41. Effect of Riociguat on Pulmonary Arterial Compliance in Patients With Pulmonary Arterial Hypertension (PAH) in the Respite Study
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James R. Klinger, Pavel Jansa, David Langleben, Christian Meier, Paul A. Corris, Hossein Ardeschir Ghofrani, Laura Scelsi, Robert Naeije, Gérald Simonneau, Ekkehard Grünig, Marius M. Hoeper, Dennis Busse, Thenappan Thenappan, Stephan Rosenkranz, and Raymond L. Benza
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Pulmonary and Respiratory Medicine ,Compliance (physiology) ,medicine.medical_specialty ,business.industry ,Respite care ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,Intensive care medicine ,Riociguat ,medicine.drug - Published
- 2017
42. Diagnostic Work-Up and Risk Stratification in X-Linked Dilated Cardiomyopathies Caused by Dystrophin Defects
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Alessandra Ferlini, Luigi Tavazzi, Oreste Febo, Laura Scelsi, Eloisa Arbustini, Fabiana Isabella Gambarin, Alessandra Serio, Emanuela Agozzino, Marta Diegoli, Catherine Klersy, Valentina Favalli, Jagat Narula, Maurizia Grasso, Michele Pasotti, and Giovanni Piccolo
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Adult ,Cardiomyopathy, Dilated ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Lower risk ,heart transplantation ,X-linked dilated cardiomyopathy ,dystrophin ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Interquartile range ,Genes, X-Linked ,Internal medicine ,medicine ,Humans ,Heart transplantation ,Ejection fraction ,business.industry ,Dilated cardiomyopathy ,Middle Aged ,medicine.disease ,3. Good health ,Transplantation ,congestive heart failure ,Heart failure ,Mutation ,Cardiology ,serum creatine phosphokinase ,business ,Cardiology and Cardiovascular Medicine ,030217 neurology & neurosurgery ,Follow-Up Studies ,Genome-Wide Association Study - Abstract
Objectives We sought to describe the diagnostic work-up, phenotype, and long-term evolution of dilated cardiomyopathy (DCM) associated with Dystrophin (DYS) defects. Background X-linked DCM associated with DYS defects can be clinically indistinguishable from other types of DCM. Methods The series comprises 436 consecutive male patients diagnosed with DCM. Patients underwent endomyocardial biopsy (EMB). Genetic testing employed multiplex polymerase chain reaction and multiple ligation dependent probe assay for deletions and direct sequencing of the 79 exons and flanking regions of the gene for point mutations or small rearrangements. Results We identified DYS defects in 34 of 436 patients (7.8%) (onset age 34 ± 11 years, age range 17 to 54 years); 30 had proven X-linked inheritance. The 2 phenotypes included DCM with mild skeletal myopathy and/or increased serum creatine phosphokinase (n = 28) or DCM only (n = 6). The EMB showed defective dystrophin immunostain. The DYS defects consisted of 21 in-frame deletions and 11 out-of-frame deletions as well as 1 stop and 1 splice-site mutation. During a median follow-up of 60 months (interquartile range: 11.25 to 101.34 months) we observed 17 events, all related to heart failure (HF) (median event-free survival: 83.5 months). Eight patients (23%) underwent transplantation, and 9 (26%) died of HF while waiting for transplantation. Eight patients received an implantable cardioverter-defibrillator, although none had device intervention during a median follow-up of 14 months (interquartile range: 5 to 25 months). No patient died suddenly, suffered syncope, or developed life-threatening ventricular arrhythmias. Conclusions DYS-related DCM should be suspected in male patients with increased serum creatine phosphokinase (82%) and X-linked inheritance. The disease shows a high risk of end-stage HF but a lower risk of life-threatening arrhythmias.
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- 2011
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43. Inappropriate exercise-induced increase in pulmonary artery pressure in patients with systemic sclerosis
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Antonello D'Andrea, Rita Camporotondo, F. Allocca, Roberto Caporali, Laura Scelsi, Paola Argiento, Anna Sara Pazzano, Gabriele Valentini, Stefano Ghio, Giovanna Cuomo, Michele D'Alto, Lorenzo Cavagna, Raffaele Calabrò, D'Alto, M, Ghio, S, D'Andrea, A, Pazzano, A, Argiento, P, Camporotondo, R, Allocca, F, Scelsi, L, Cuomo, Giovanna, Caporali, R, Cavagna, L, Valentini, Gabriele, and Calabro', Raffaele
- Subjects
Adult ,Male ,medicine.medical_specialty ,Systole ,Population ,Blood Pressure ,Pulmonary Artery ,Nyha class ,Diastole ,medicine.artery ,Internal medicine ,medicine ,Humans ,In patient ,Prospective Studies ,education ,Exercise ,Aged ,Subclinical infection ,education.field_of_study ,Scleroderma, Systemic ,High prevalence ,business.industry ,Interstitial lung disease ,Middle Aged ,medicine.disease ,Blood pressure ,Echocardiography ,Pulmonary artery ,Ventricular Function, Right ,Cardiology ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Recent data show that there is an unexpectedly high prevalence of ‘inappropriate’ pulmonary responses to exercise among patients with systemic sclerosis (SS). However, no consensus exists as to which threshold of pulmonary artery systolic pressure (PASP) can be considered diagnostically relevant. Aim To evaluate pulmonary vascular reserve and right ventricular function changes induced by exercise in SS patients without overt pulmonary arterial hypertension. Methods and results The study enrolled 172 consecutive SS patients in NYHA class IeII, with a peak tricuspid regurgitant jet velocity at echocardiography not greater than 3 m/s, and 88 control subjects. Echocardiography was performed at rest and at the end of a maximal exercise test. SS patients showed a higher exercise-induced PASP than control subjects (36.968.7 vs 25.963.3 mm Hg, p¼0.00008). The response to effort was higher in the presence of moderate interstitial lung disease (39.769.3 vs 36.068.4 mm Hg, p¼0.016) or subclinical left ventricular diastolic dysfunction (42.365.8 vs 37.068.6 mm Hg, p¼0.015). In control subjects, PASP values were normally distributed at rest and after exercise. In SS patients, the distribution was normal at rest but bimodal after exercise, with a second peak at 52.2 mm Hg including 13% of the total SS population. Patients in this subgroup showed subtle abnormalities of right ventricular function at rest and, most importantly, a blunted increase in right ventricular systolic function with exercise. Conclusion Exercise echocardiography may identify a subset of SS patients with an inappropriate exercise-induced increase in PASP and early signs of right ventricular dysfunction.
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- 2010
44. Cardiac arrest seen by the relatives of the cardiology patients: High risk and poor preparation
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Franca Contin, Luigi Oltrona Visconti, Laura Scelsi, Enrico Baldi, Claudia Raineri, Stefano Ghio, Annalisa Turco, Simone Savastano, Gaetano M. De Ferrari, and Aurora Ilaria Danza
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medicine.medical_specialty ,business.industry ,Emergency medicine ,Emergency Medicine ,medicine ,Emergency Nursing ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
45. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension
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Catherine Klersy, Mario Viganò, Carlo Campana, Michele Pasotti, Claudia Raineri, Giulia Magrini, Laura Scelsi, Stefano Ghio, Andrea Maria D'Armini, and Alessandra Serio
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Male ,medicine.medical_specialty ,Elevated pulmonary artery pressure ,Heart Ventricles ,Hypertension, Pulmonary ,medicine.medical_treatment ,Idiopathic Pulmonary Hypertension ,Diastole ,Regurgitation (circulation) ,Severity of Illness Index ,Inferior vena cava ,Superior vena cava ,Internal medicine ,medicine ,Humans ,Lung transplantation ,Prospective Studies ,cardiovascular diseases ,Proportional Hazards Models ,business.industry ,Middle Aged ,Prognosis ,Survival Analysis ,Echocardiography, Doppler ,medicine.anatomical_structure ,ROC Curve ,medicine.vein ,Echocardiography ,Ventricle ,Catheterization, Swan-Ganz ,Ventricular Function, Right ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In patients with idiopathic pulmonary hypertension (IPAH) progression of the disease and survival are related to the capability of the right ventricle to adapt to the chronically elevated pulmonary artery pressure. Although several echocardiographic variables have been associated with outcome in previous studies, a comparative evaluation of all right ventricular (RV) function indices obtainable at echocardiography has never been performed. Methods 59 patients consecutively admitted in a tertiary referral centre because of IPAH (22 males, mean age 46.3±16.1 years, 68% in WHO class III/IV at referral) underwent right heart catheterization and echocardiography. During a median follow-up period of 52 months, 21 patients died and 2 underwent lung transplantation in emergency conditions. Results The following parameters were associated with survival: tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, degree of tricuspid regurgitation, inferior vena cava collapsibility, superior vena cava flow velocity pattern, left ventricular diastolic eccentricity index. Patients with TAPSE≤15 mm and left ventricular eccentricity index ≥1.7 had the highest event rate (51.7 per 100 person year); patients with TAPSE>15 mm and mild or no tricuspid regurgitation had the lowest event rate (2.6 per 100 person year). Conclusions A comprehensive echocardiographic assessment of RV systolic and diastolic function based on TAPSE, left ventricular diastolic eccentricity index and degree of tricuspid regurgitation allows an accurate prognostic stratification of patients with IPAH.
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- 2010
46. Usefulness of cardiac magnetic resonance in assessing the risk of ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy
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Michele Pasotti, Sergio Leonardi, Marilena Tagliani, Gaetano M. De Ferrari, Laura Scelsi, Adele Valentini, Claudia Raineri, Roberto Dore, Stefano Ghio, Eloisa Arbustini, and Arturo Raisaro
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Adult ,Male ,medicine.medical_specialty ,Heart disease ,Ventricular tachycardia/fibrillation ,Ventricular tachycardia ,Risk Assessment ,Sudden death ,Sudden cardiac death ,Risk Factors ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Risk factor ,Retrospective Studies ,business.industry ,Cardiovascular magnetic resonance ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Death, Sudden, Cardiac ,Mutation ,Ventricular fibrillation ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Magnetic Resonance Angiography - Abstract
Aims To assess the relationship between cardiovascular magnetic resonance (CMR) parameters and both spontaneous ventricular tachycardia (VT) and risk of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) patients. Methods and results One hundred and eight consecutive HCM patients (mean age 42 ± 15 years, 76% males) underwent CMR evaluation and risk assessment. Delayed contrast enhancement (DCE) was quantified with a specifically designed score. Endpoints were either the presence of clinical VT/ventricular fibrillation (VF) or of acknowledged risk factors for SCD. Compared to patients without arrhythmia, those with VT/VF ( n = 33) had a higher DCE score [median 8 (2–13) vs. 11 (6–20); P = 0.01]; DCE score was also the only independent predictor of VT/VF in the multivariable model. DCE score [median 6 (1–10.5) vs. 12 (6–18); P = 0.001], mean and maximal left ventricular (LV) wall thickness (MaxLVWT), as well as LV mass index were significantly greater among patients at risk for SCD ( n = 51) compared with the remaining 57 patients at low risk. DCE score and MaxLVWT were independent predictors of SCD risk. Conclusion In HCM patients several CMR parameters are associated with risk for SCD. A semi-quantitative index of DCE is a significant multivariable predictor of both clinical VT/VF and of risk for SCD and may contribute to risk assessment in borderline or controversial cases.
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- 2009
47. Long-term left ventricular reverse remodelling with cardiac resynchronization therapy: results from the CARE-HF trial
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Stefano Ghio, Aparna Shankar, Alessandra Serio, Giulia Magrini, Michele Pasotti, John G.F. Cleland, Nick Freemantle, Luigi Tavazzi, and Laura Scelsi
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Male ,medicine.medical_specialty ,Time Factors ,Heart Ventricles ,medicine.medical_treatment ,Electric Countershock ,Cardiac resynchronization therapy ,law.invention ,Electrocardiography ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Carvedilol ,Aged ,Heart Failure ,Ejection fraction ,Ventricular Remodeling ,medicine.diagnostic_test ,business.industry ,Recovery of Function ,Middle Aged ,medicine.disease ,Myocardial Contraction ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Heart failure ,Cardiology ,Female ,Core laboratory ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Aims The aim of the present study was to assess the long-term effects of cardiac resynchronization therapy (CRT) on the reverse remodelling of the left ventricle (LV). Methods and results The effects of CRT compared with controls on LV dimensions and function were assessed at 3, 9, and 18 months and at the end of study (average 29 months) in 735 (90%) patients with adequate echocardiographic examinations, randomized in the CARE-HF trial. Echocardiographic recordings were submitted to a core laboratory to ensure consistent quantitative analysis. LV volume decreased and ejection fraction increased substantially in the CRT group by 3 months and improved further at each assessment when compared with the control group. Effects were less marked in patients with ischaemic heart disease and those with right ventricular dysfunction, but not in patients with a restrictive LV filling pattern. The extent of reverse remodelling at 18 months showed a modest relationship with baseline interventricular mechanical delay (IVMD). Conclusion CRT induces sustained LV reverse remodelling with the most marked effects occurring within the first 3–9 months. The extent of remodelling in response to CRT is related to the aetiology of heart failure and, to a lesser extent, to the IVMD.
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- 2009
48. Reverse right ventricular remodeling after pulmonary endarterectomy
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Andrea Maria D'Armini, Giulia Magrini, Stefano Ghio, Giulia Meloni, Mario Viganò, Laura Scelsi, Catherine Klersy, Matteo Pozzi, and Giorgio Zanotti
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Hypertension, Pulmonary ,Endarterectomy ,Pulmonary Artery ,Cardiovascular Physiological Phenomena ,Right ventricular hypertrophy ,Internal medicine ,medicine.artery ,Medicine ,Humans ,Ventricular remodeling ,Aged ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Ventricle ,Echocardiography ,Pulmonary artery ,Cardiology ,Vascular resistance ,Ventricular Function, Right ,Female ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objectives We sought to evaluate the capability of the right ventricle to regain normal morphology and function after pulmonary endarterectomy, to correlate right ventricular reverse remodeling with functional status, and to identify independent predictors of clinical failure after surgical intervention. Methods From December 2000 through August 2003, 45 patients underwent isolated pulmonary endarterectomy. Morphology and function of the right ventricle were studied by using a combination of right heart catheterization, cardiac magnetic resonance, and transthoracic echocardiography. Functional status was evaluated by using New York Heart Association class. Full preoperative data were available for 37 candidates. All patients were evaluated before discharge, at 3 months, and at 1, 2, and 3 years postoperatively using the same modalities. Results Immediately after surgical intervention, right ventricular cavitary dimensions decreased significantly, and tricuspid regurgitation radically improved. Right ventricular ejection fraction and functional status improved and right ventricular hypertrophy reversed over a longer time period. Higher ventricular dimensions and lower ejection fraction of the right ventricle were associated with poorer functional status at any time postoperatively. At discharge, pulmonary vascular resistance of greater than 509 dyne·sec·cm −5 and right ventricular ejection fraction of 24% or less predicted clinical failure at 12 months' follow-up. Conclusions After pulmonary endarterectomy, the right ventricle recovers and maintains normal architecture and function over time, regardless of the severity of preoperative disease. Accurate preoperative evaluation of the hemodynamics and anatomy of the thromboembolic lesions are mandatory. If pulmonary endarterectomy is not expected to decrease pulmonary vascular resistance to less than 509 dyne·sec·cm −5 , indication for surgical intervention needs to be carefully evaluated.
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- 2007
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49. Changes in surface electrocardiogram in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Correlations with hemodynamic and echocardiographic improvements after surgery
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Valentina Grazioli, Claudia Raineri, Valeria Crescio, Antonio Sciortino, Arianna Viscardi, Stefano Ghio, Annalisa Turco, Andrea Maria D'Armini, Luigi Oltrona Visconti, Laura Scelsi, and Catherine Klersy
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Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Statistics as Topic ,Hemodynamics ,Endarterectomy ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Sensitivity and Specificity ,Pulmonary endarterectomy ,Muscle hypertrophy ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,business.industry ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Surgery ,Surface electrocardiogram ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Ventricle ,Echocardiography ,Anesthesia ,Chronic Disease ,Cardiology ,Chronic thromboembolic pulmonary hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
Background The aim of the present study was to evaluate the changes of electrocardiographic (ECG) markers of right ventricular (RV) hypertrophy/overload in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA). Methods and results We evaluated 99 CTEPH patients who underwent PEA. P wave amplitude in DII, R wave amplitude in V1 and the number of patients with negative T wave in V1–V3 decreased significantly at 1 month after surgery with no further change at 1 year, in parallel with the rapid improvement in right heart hemodynamics. S wave amplitude in V1, R:S wave ratio in lead V6 and prevalence of SIQIII pattern improved significantly at 1 year, in parallel with the progressive reverse remodeling of the right ventricle at echocardiography. Conclusions The study shows that some of the ECG markers of RV hypertrophy/overload better reflect RV hemodynamic overload while others better reflect the pathologic remodeling of the right ventricle.
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- 2015
50. Rescreening of ?healthy? relatives of patients with dilated cardiomyopathy identifies subgroups at risk of developing the disease
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Alessandra Repetto, Eloisa Arbustini, Stefano Ghio, Carlo Campana, Lorenzo Monti, Giulia Magrini, Alessandra Bertoletti, Michele Pasotti, Luigi Tavazzi, Laura Scelsi, Alessandra Serio, and Alessandra Fontana
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medicine.medical_specialty ,Pediatrics ,medicine.diagnostic_test ,Heart disease ,business.industry ,Physical examination ,Dilated cardiomyopathy ,Disease ,medicine.disease ,Asymptomatic ,Surgery ,cardiovascular system ,medicine ,cardiovascular diseases ,Risk factor ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block ,Familial disease - Abstract
Objectives To test the diagnostic impact of the non-invasive rescreening of relatives of index patients consecutively diagnosed as having dilated cardiomyopathy. Background The aim of rescreening asymptomatic healthy relatives of DCM patients is to diagnose newly affected subjects and evaluate the predictive significance of the instrumental abnormalities found at the first screening. Methods and results Two hundred and three healthy relatives of 73 consecutive index patients with DCM (18 with familial disease at first screening) underwent rescreening involving a clinical examination, electro- and echocardiography, and biochemical tests a median of 29.3 months after the first screening. Seven relatives had developed the diagnostic criteria for DCM during the screening–rescreening interval. Of the 24 healthy relatives with left ventricular end-diastolic diameter enlargement and normal function at the first screening, nine had normalised, seven showed persistent enlargement, three had worsened, and five had developed the disease criteria at rescreening. Of the three relatives with atrioventricular block at the first screening, one had developed DCM. Finally, one of the relatives with normal echocardiographic and electrocardiographic results at the first screening, had developed the disease. Three of the newly diagnosed subjects came from families with evidence-based familial DCM, and four from families with what was defined as sporadic DCM at the first screening. Conclusions Medium-term rescreening of the relatives of DCM patients can identify a significant number of newly affected patients (3.5%).
- Published
- 2004
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